Summary Report for FSPSAs Ending During the Report Period Center: 03
This report shows the total number of units/fees for FSPSAs ending during the report period.
(i.e., end date of service authorization occurs during the report period). This report does not
represent all FSPSAs that overlap the report period. Note that service authorization periods may
range from 1 to 12 months and may vary in intensity from child to child.
FSPSAs ending between: 07-01-22 and 06-30-23 Date of Report: 07-25-23 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 3592 FSPSA's found
Services Cpt Code Number of Number of Total Units Total Cost of Avg Fee
Children Records Authorized Auth Services Per Unit Auth
Service Coordination, Class # 01
SCONLY-SCONLY *SERVICE COORDINATION ONLY 138 166 227.281747 $0.0000 $0.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 138 166 227.281747 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 33 47 39.988889 $1939.4600 $48.5000
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 2 2 2.000000 $57.8400 $28.9200
OCTH -97165 OT EVAL LOW COMPLEXITY 58 89 61.351447 $3154.0800 $51.4100
OCTH -97167 OT EVAL HIGH COMPLEXITY 8 12 5.405554 $277.8900 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 55 81 66.251589 $3406.0000 $51.4100
PSTH -97163 PT EVAL HIGH COMPLEXITY 46 71 40.888894 $2102.1200 $51.4100
SPCH -92521 EVAL OF SPEECH FLUENCY 5 5 12.415873 $638.3000 $51.4100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 116 201 128.561037 $6609.3300 $51.4100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 2 1.205555 $61.9700 $51.4100
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 253 510 358.068838 $18247.0000 $50.9600
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 33 43 38.253046 $191266.5000 $5000.0300
CONIF -CONIF CONSULT, ITDS FACE TO FACE 45 64 152.402379 $7620.1100 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 177 262 564.155552 $28207.7600 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 96 157 317.344445 $15867.2300 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 185 277 594.846821 $29742.3300 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 793 1539 11296.030168 $564801.5100 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 67 123 1121.460319 $80700.3000 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 108 208 1556.061908 $111974.2200 $71.9600
SENS -V5050 IN EAR MONAURAL HEARING AID 1 1 0.402740 $92.4600 $229.5900
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 123 242 1587.123806 $114209.4100 $71.9600
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 1051 2916 17228.081184 $1144481.8300 $66.4300
-------------------------------------------------------------------------------------------------------------------------------------
Total 3592 17813.431769 $1162728.8300 $65.2700
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 1154